Pain at the Ball of the Foot (Lesser-ray Transfer Metatarsalgia)

There are five long bones in our feet called metatarsals, and when working properly, weight-bearing forces are shared between all of them. The largest of these five metatarsals, the first metatarsal, is the one connected to the big toe. It is the largest of the five metatarsals, and handles a significant portion of the weight-bearing forces.

Sometimes the first metatarsal will have excessive pressure on it, which causes the joint connecting it to the midfoot to get loose. This loosening allows the first metatarsal to “go on vacation.” When that happens, the weight bearing forces that it used to bear now goes to the smaller, “lesser”, metatarsals. This is like a domino effect moving from the inside/medial part of the foot and progressing toward the outside/lateral part of the foot. This can cause pain in the forefoot, and can be accelerated by high arches, flat feet, hammer / claw toes, restrictive footwear, and/or a tight calf muscle.

Relationship to “Morton’s Neuroma”

Sometimes people are told they have a “Morton’s Neuroma.” This is actually a misnomer since there really is no “neuroma” at all. What’s really happening is that the nerve that goes between the ends of two of the metatarsals is being compressed. This is similar to a carpal tunnel syndrome in the wrist. With carpal tunnel syndrome, the solution is to release the pressure on the nerve by changing activity/position or by cutting the soft tissues around the nerve (not cutting out the nerve itself).

In the foot, the best solution for this problem is to figure out what is compressing this nerve and address that (instead of just cutting out the nerve). This is often due to shoes with a tight toe box. Most shoes (probably 99%) are designed incorrectly and have too narrow of a toe box. Changing to shoes with a wider, “foot-shaped” toe box can make a “Morton’s Neuroma” go away completely. (Click here for a list of shoes that Dr. Hoopes recommends) This always worse when someone has a tight calf muscle (gastroc equinus) since it places more stress on the forefoot to begin with. Then, the shoes with a narrow toe box come in and finish the job to give the forefoot/toe pain and numbness.